Opponents have bashed the Clinton administration's healthcare reform proposal on several counts. Many attacks-particularly by those alarmed about the colossal undertaking involved in establishing a system of state-run regional healthcare alliances-have been right on target. Others arguably have been tainted by their association with special interest groups.
The American Medical Association's latest plan to lobby for significant changes in the President's Health Security Act seems to fall in the latter camp. The AMA's objectives, spelled out in a confidential letter to lobbyists for medical specialty societies, focus primarily on physician pocketbook issues. They include obtaining an antitrust exemption so physicians can negotiate fees collectively and-no surprise here-eliminating proposed restrictions on physicians' fees.
Late last year, the AMA waffled on its earlier support of an employer mandate as a way of achieving access to care. Now it's stepping up efforts to fight reductions in Medicare payments, an effort also pursued by American Hospital Association executives.
Both associations run the risk of being viewed as obstructionist unless they provide solid alternatives for keeping costs down. Creating networks of care won't necessarily provide such relief. Industry leaders must offer concrete, realistic approaches for paring costs.
A more valid criticism of the plan recently came from the economist who is the architect of managed competition. Alain Enthoven, professor at Stanford University's graduate school of business, warned this month that the president's plan wouldn't work and suggested that Congress should "delete pages 1 through 1,342 of Clinton's 1,342-page bill."
Although these are strong comments, Mr. Enthoven long has opposed the Clinton proposal on the grounds that it incorporates no limits on tax deductibility for employer-provided health benefits or other incentives to change consumer behavior.
Adopting a health reform plan that counts on government bureaucracy rather than consumer-based pressures to reward efficient providers and penalize inefficient or extravagant caregivers is doomed to failure.